Taiwan could teach the USA about the leap to single payer healthcare
brian wang | January 3, 2018 From: nextbigfuture.com In 1995, Taiwan chose William Hsiao, a professor of economics at the Harvard T.H. Chan School of Public Health, to lead a task force to design a new healthcare system. Uwe Reinhardt, a longtime Princeton professor, also contributed significantly to the effort. Taiwan chose to adopt a single-payer system like that found in Medicare or in Canada, not a government-run system like Britain’s. At first, things did not go as well as hoped. Although the country had been planning the change for years, it occurred quite quickly after democracy was established in the early 1990s. The system, including providers and hospitals, was caught somewhat off guard, and many felt that they had not been adequately prepared. The public, however, was much happier about the change. Today, most hospitals in Taiwan remain privately owned, mostly nonprofit. Most physicians are still either salaried or self-employed in practices. The health insurance Taiwan provides is comprehensive. Both inpatient and outpatient care are covered, as well as dental care, over-the-counter drugs and traditional Chinese medicine. It’s much more thorough than Medicare is in the United States. Access is also quite impressive. Patients can choose from pretty much any provider or therapy. Wait times are short, and patients can go straight to specialty care without a referral. Relative to the United States and some other countries, Taiwan devotes less of its economy to health care. In the early 2000s, it was spending 5.4 percent of G.D.P., and by 2014 that number had risen to 6.2 percent. By comparison, countries in the Organization for Economic Cooperation and Development spend on average more than 9 percent of G.D.P. on health care, and the United States spends about twice that. The New York Times had a panel compare the national health care systems of Canada, Britain, Singapore, Germany, Switzerland, France, Australia and the U.S. Britain was deemed better than Canada because it has shorter waiting times with similar costs. The USA was deemed to be better than Singapore. Singapore has large mandatory savings accounts. Singapore’s system costs far less than America’s (4.9 percent of G.D.P. versus 17.2 percent). Singapore doesn’t release the same data as most other advanced nations, although it’s widely thought that it provides pretty good care for a small amount of spending. France was deemed to be better than Australia. The French health system is relatively expensive at 11.8 percent of G.D.P., while Australia’s is at 9 percent. Access and quality are excellent in both systems. People in France report somewhat fewer problems getting access to care, as well as shorter waiting times. Switzerland was deemed to be better than Germany. Switzerland was deemed to be better than Britain. Switzerland has better facilities and speed of access to care. France was deemed to be better than the US healthcare system. The U.S. is just too expensive for what it delivers and includes too much financial insecurity to boot. Switzerland was deemed to be better than France. The Swiss health care system delivers a higher quality of care across a range of measures and invests more in innovation that fuels new knowledge and, ultimately, better treatments that we all benefit from. The French system is cheaper, its financing is more equitable, and its system is simpler. Germany would have tied Switzerland had they averaged their rankings of the nations instead of using head-to-head matchups in a bracket system (Switzerland eliminated Germany in the first round). It’s an example of how close the voting was. Not one vote was unanimous among the judges, and all the semifinal and final votes were 3-2. Clearly, there is room for disagreement about the relative merits of health systems, and different experts would surely reach different conclusions. Some judges took a global view, giving the edge to countries, like the United States, that promoted innovation that benefited the rest of the world. In other cases, how health systems treated the poorest of society was paramount.